CMS Announces 2016 Hospital Appeals Settlement Process

Hospitals with pending appeals before an administrative law judge or the departmental appeals board may see some relief. Eligible providers can settle denied inpatient claims that are currently under review for 66% of the net allowable amount in exchange for withdrawing certain pending appeals under the 2016 Hospital Appeals Settlement Process, CMS announced.

CMS announced details of the settlement process in a November 16 MLN Connects National Provider Call. Only acute care hospitals and critical access hospitals are eligible to submit a settlement request. Eligible hospitals can initiate the process by submitting a completed expression of interest to CMS at MedicareAppealsSettlement@cms.hhs.gov. After determining the provider’s eligibility, CMS will generate a list of claims that will be included in the settlement. Hospitals must agree to the overall settlement and cannot choose to settle some claims while continuing to appeal others.

The 2016 settlement process mirrors that offered in 2014. Under the 2014 settlement process, CMS paid roughly $1.47 billion to more than 2,000 hospitals.